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5.27 pm
The Parliamentary Under-Secretary of State for Health (Mr. David Lammy): I congratulate the hon. Member for Guildford (Sue Doughty) on securing this debate on an issue that is of concern to her and to many hon. Members, and on the great sincerity and tremendous vigour with which she pursues it. I am well aware of the excellent services provided by children's hospices, especially the hospice to which she refers. My constituency is served by the Haven House hospice in Waltham Forest, and we are grateful for all the good work that hospices do. As the hon. Lady would expect, the Government are absolutely committed to helping children with life-threatening illnesses and we value and support the tremendous contribution made by the hospice movement.
This is a complicated area and there is much to say. Children with life-threatening conditions need a very special form of care. First and foremost, they are children and they want to behave and be treated like other children, but the care should be tailored to the individual nature of the illness, its progression and the variety of individual family circumstances and preferences. All those factors are relevant to the support that is offered. We as a Government have long recognised that respite, short-break care is essential, as it allows the family time to rest and enables them to continue to care for the ill child, siblings and themselves. It also brings the opportunity for peer socialising for children and young people, which can be difficult to access elsewhere.
We also know that the death of a child is the most devastating experience any parent can have. How children die, how they are supported in their dying and the quality of after-death care have a major impact on how families cope with their grief. Children and families have individual needs that should be recognised; they should be afforded time and space and treated with respect and dignity. Hospices can have a major role in all of this, from the overall approach to the care pathway, to the smaller but individually life-enhancing elements of care.
The way in which the hospice movement has evolved means that buildings are quite often put in place before discussions have been held about how the services will be supported. We must ensure that there is more synergy between capital funding and revenue funding.
The hon. Lady will know that the first children's hospice came about in about 1982. We have had 20 years of children's hospices, and more are being built. We have more than 20 now. More are being built because good local people come together and want to provide. They want a charitable facility. Important discussions about ongoing revenue are essential and vital, so there is a complicating factor in this relatively new hospice development.
We are aware of the difficulties and have been working with and supporting the Association for Children with Life-Threatening and Terminal Conditions and their Families in producing guidance on effective approaches to providing the range of palliative care that is necessary. We also have a continuing dialogue with the Association of Children's Hospices, which is enormously helpful as many hospices, as I have explained, are in their infancy, and developing. Some are only a year or so away from their official opening. That is one reason why the funding base for children's hospices has not been well embedded.
In terms of securing health funding, it is for primary care trusts to negotiate locally what sort of services are needed in their communities. To do so, they must have a genuine relationship with the voluntary sector to see how those services can be provided. There must be a proper discussion at local level that relates to funding decisions. I urge hospices to get into that discussion—both those established and those in planning—with their PCT partners and their strategic health authorities.
Sue Doughty: CHASE has attempted to contact all its PCTs but they do not reply, even to letters.
Mr. Lammy: The Department of Health would look into any issue where a health provider had written a letter and had not received a reply.
I say with as much sincerity as I can that the Department has rightly come to the conclusion that it cannot attempt to run the entire health service from Whitehall. As the hon. Lady knows, we have localised down to primary care trusts and to strategic health authorities. At the same time—this is different from the context in which she has raised these matters in the past—we have said to PCTs, "We have increased your allocations"—that is the fact—"way beyond inflation, between 7 and 9 per cent. You have this money for three years. You can now plan your cycle or journey, as it were, with different health providers over a range of issues for three years." That is a difference.
Of course, primary care trusts are coming out of their infancy as new organisations and are clustering together. Strategic health authorities are taking an interest. That must be the right position. I am not saying that it is perfect, but what I have outlined must be the starting premise. Alongside that, as I shall explain, the national service framework for children and the work that we hope to do next year are vital, as they raise the game, concentrating the minds of people in primary care trusts and strategic health authorities on what they are doing and the standards that are in place. We are on a journey, but the funding that has been provided through the New Opportunities Fund adds up nationally to
£14 million just on palliative care awards to hospices. In addition, there is the national service framework, a three-year period of funding, and an increase in funding, so I am sincere in saying we are in a stronger position in this area than we have been for some time.To get the most out of palliative care services for children, we need to remember what makes them different. The ideal is to have a range of services available that recognise that children's palliative care is unique because it is part of the journey of care and therefore of life, and not the end stage, as it is for adults. It is as much about the quality of living as the quality of dying. It is not just "what you do when nothing else is left". It should be part of the care provided as soon as it is clear that a child or young person has a life-threatening or life-limiting illness. It requires a comprehensive approach for the child and family, and challenges all patient and professional services to develop a wider understanding that palliative care is an active approach to management.
That adds up to the need for real partnership, based on honest and open communication free, I hope, of jargon. Above all, it means thinking intelligently and humanely about the specific needs that a child or family may have, which can only be gained through partnership. That is the premise from which we start in the Department. That is what we are pushing and it is the thrust of the national service framework. It is the challenge in palliative care for children to which we expect our PCTs and strategic health authorities to step up. Partnerships need to focus more on areas where provision has been difficult in the past because of geographical spread. The hon. Lady will know that the desire of good people to open a children's hospice is such that there may be neighbouring hospices or hospices with a wide geographical spread. The Department of Health has little control over the demography of children's hospices, but we have to respond nevertheless to the need for tailored support for specific illnesses, conditions and age ranges for which there may have been a lack of provision in the past. We must also take into account the needs of minority ethnic communities, whose access to health and social services is less than it should be.
What needs to be changed to help hospices to secure funding? There are a number of issues, but clearly if any initiative is to be funded, funding must be available to PCTs. If we expect them to take a view on what may be an increasing demand on their resources, we must ensure that they are aware of the potential and the benefits of hospice care. We must also work up a framework to guide and assist positive partnerships. We need to address those issues and I am glad that we can now do so from the strongest position that we have ever occupied. It may not yet be the gold standard that we all desire—the hon. Lady is an active campaigner on the issue—but we are in the strongest position and we have a good foundation. The money that we are providing to hospices through the New Opportunities Fund is also important, and is made available through the work of the Department of Health and the Department for Culture, Media and Sport, where that money is located, so to speak.
Hon. Members will recall that in December my right hon. Friend the Secretary of State for Health announced the allocation of £148 billion to primary care trusts over the next three years, as I have outlined. That represents a cash increase of more than 30 per cent., and means that no PCT will receive an increase in funding of less than 28 per cent. over the next three years. From April this year, local PCTs will control over 75 per cent. of the NHS budget, and the average PCT budget will grow over the next three years by almost £42 million.
Sue Doughty: I hope I am not being too cynical, and I would not want to seem ungrateful for the NOF money—of course we are grateful for it—but from what has been said I am learning that PCTs should be paying towards hospices, but they are not. They have more money, partly from the Department of Health and partly from the lottery, and some of that should be going to the hospices. Are hospices still being funded mainly by lottery money? What about free nursing care? What about nursing care for children when they leave NHS facilities? Does the Department of Health have any direct responsibility?
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